| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $562.79 | $562.79 | $562.79 | |
Cigna
| Facility | $167.99 | $416.63 | $486.74 | |
Medica
| Facility | $148.90 | $148.90 | $247.17 |
Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $562.79 | $562.79 | $562.79 | |
Cigna
| Facility | $167.99 | $416.63 | $486.74 | |
Medica
| Facility | $148.90 | $148.90 | $247.17 |